DiversityNursing Blog

According to a recent survey conducted by Wolters Kluwer Health’s Lippincott Williams & Wilkins (LWW), 71 percent of nurses are already using smartphones for their job. The survey included responses from 3,900 nurses and nursing students. About 66 percent of those nursing students surveyed said they use their smartphones for nursing school.

Overall, 85 percent of the nurses and nursing students said they want a smartphone app version of LWW’s Nursing 2013 Drug Handbook. Some 87 percent of those surveyed said they would want a smartphone app version of the text as well as a print version.

This month LWW plans to launch its first mobile app version of the handbook. The new forthcoming app includes nearly 900 drug monographs addressing more than 3,000 generic and brand name drugs. The app also offers a dosage calculator, pill images, detailed monographs and weekly drug updates. The app will work on iPhone, iPad, and Android devices once it launches later this month.

Earlier this year the New York Times reported on the effects of the increased adoption of smartphones among students at nursing schools: “The most profound recent change is a move away from the profession’s dependence on committing vast amounts of information to memory. It is not that nurses need to know less, educators say, but that the amount of essential data has exploded,” the Times wrote.

In January Massachusetts General Hospital also announced plans to equip its nurses with iPhones thanks to a recent deal with Voalte. Voalte’s offering combines high-definition voice calls, critical care alarms and presence-based text features and is intended for use by staff in acute care hospitals in the US and Canada — especially nurses. The company has helped a number of healthcare facilities equip their nurses with smartphones, including, Cedars-Sinai, Nebraska Medical Center, Texas Children’s, Heartland Health, Huntington Hospital, and Sarasota Memorial.

2010 may have been the year when enormous healthcare changes began, but 2011 was the year these changes hit nursing. In addition, the Institute of Medicine's landmark Future of Nursing report was released at the end of 2010 and much of this year has been spent digesting its recommendations and searching for ways to put them into practice.

Here's a quick rundown of the most pressing issues for Nursing in 2012:

1. Advanced degrees are no longer optional

The IOM's recommendation for 80% of all RNs to have a baccalaureate degree by 2020 has not veered too intensely into the old ADN vs. BSN quagmire. Instead, the profession is focusing on ways to engage nurses in lifelong learning so that associate degree nurses can find realistic ways to obtain BSN degrees.

In addition, BSN nurses are encouraged to be leaders in evidence-based practice and research and it's becoming more common—and crucially, more expected—for nurses to pursue master's degrees. And the creation of the doctor of nursing practice degree has taken off better than anyone could have expected.

In the last six months, any time nurse executives get together, the conversation always turns to who has already entered a program and how long it's going to take the rest of the group to do so.

 
2. Patient engagement gets real

If you haven't found a way to drive home the importance of patient experience to direct-care nurses, find it now. You know how much reimbursement is at stake, but the rank and file caregivers still don't get it. The term "patient experience" has a way of annoying bedside caregivers. '"We're not Disneyworld," is a common refrain; people don't want to be in the hospital. "I'm here to save patients' lives, not entertain them," is another common complaint.  

Experience isn't about mollycoddling patients, however, or how flashy the in-room entertainment system is and that's what you need to help nurses understand. In fact, the nurse-patient relationship has always been about patient experience.

Your best nurses instinctively know this. They already create a good patient experience. They help patients understand their care, involve families in decision-making, coordinate multidisciplinary care, sit with patients to explain complex diagnoses, and even, occasionally, have time to offer a quick hug or hand to hold. These are the nurses who get letters from patients and families after discharge and these letters are all about the patient experience.

This is how you need to phrase patient experience with nursing staff so they understand it's not just a program, but a way of life. At the same time, nursing needs to own the cause. They may not be responsible for it in isolation, but they are literally at the center of this issue. They should take the lead and drive the agenda.

3. Patient safety

Just as nurses should own patient experience, they need to feel ownership for patient safety as well. It has been written that "quality improvement becomes one more meaningless directive from 'above' unless nurses feel engaged in the process, involved in the plans, and accountable for the results."

Preventing healthcare-associated infections (HAI) is no longer simply the right thing to do, it's become the only financially viable option. Unless nurses are educated and empowered, real progress cannot be made.

4. Cost cutting

Nursing knows that hiring freezes and layoffs are a constant threat and healthcare organizations are forced to put cost cutting at the top of the agenda in 2012. As the largest budget in the organization, nursing is an easy target.

Organizations can get more agile with staffing and scheduling and find creative ways to reduce cost while maximizing efficiency. Embrace change and flexibility to create the mobile, agile workforce healthcare organizations need to adapt to changing economic realities and increases in patient population.

At the same time, staffing budgets can't be viewed in isolation. There are direct links between nurse staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover. This article examines the danger of considering the cost of nurse staffing without looking at everything else. It's important to understand the relationship between length of stay, unreimbursed never events, and nurse staffing to understand the whole picture.

5. Retention

It's been said before, but ignore retention at your peril. The nursing shortage hasn't gone away simply because the recession has eased its immediate effects. We all know the turnover rate for new graduate nurses is always high, so invest in nurse residency programs that have proven results for retention and for increasing the competency of new nurses.

(from CNN)

The number of interracial couples in the United States has reached an all-time high, with one in every 10 American opposite-sex married couples saying they're of mixed races, according to the most recent Census data released Wednesday.

In 2000, that figure was about 7%.

The rate of interracial partnerships also is much higher among the unmarried, the 2010 Census showed.

About 18% of opposite-sex unmarried couples and 21% of same-sex unmarried partners identify themselves as interracial.

The term interracial, as it pertains to the study, is defined as members of a couple identifying as of different races or ethnicities.

Analysts suggest the new figures could reflect U.S. population shifts, broader social acceptance of such unions and a more widespread willingness among those polled to be classified as mixed race.

"Identifying as an interracial couple shifts over time," census spokeswoman Rose Kreider said.

Among interracial opposite-sex married couples, non-Hispanics and Hispanics are by far the most frequent combination, making up about 45% of such partnerships, Kreider said.

The second most represented group are those in which at least one person identifies as multiracial, while the third are marriages between whites and Asians.

Marriages between blacks and whites are the fourth most frequent group among married opposite-sex interracial couples.

Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.

But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.

The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.
The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.

It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.

The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.
In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.

Cost questions

There are still plenty of questions regarding professional interpreters, according to Flores.
For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.

There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective. Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not. So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs." But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.

As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.

Another issue is training -- including the question of how much is enough. In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm. There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.

As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said. Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.

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Have you ever used a translator as a nurse or as a patient? How did it go? What is the ideal training program?

By definition...

Cultural competency is having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Obtaining cultural competency is an ongoing, lifetime process, not an endpoint. Becoming culturally competent requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups.

Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. In the United States, these inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power.

Models

Several models of cultural competency exist. In a model called The Process of Cultural Competence in the Delivery of Healthcare Services, by Campinha-Bacote, nurses are directed to ask themselves questions based on the five constructs-awareness, skill, knowledge, encounters, and desire (ASKED)-to determine their own cultural competency. According to this model, nurses need an awareness of their own cultural biases and prejudices, cultural knowledge, and assessment and communication skills. Nurses also need to be motivated to have encounters with culturally diverse groups. In its most recent form, this model suggests that these encounters are the pivotal key constructs in the process of developing cultural competency.

The Giger and Davidhizar Transcultural Assessment Model identifies six cultural phenomena nurses and other healthcare providers assess in their patients: biological variations, environmental control, time, social organization, space, and communication.

Staff should select a model that best fits your specific work setting and patient population.

Beware stereotypes

Discussions about culture in healthcare often focus on race and ethnicity. Taking this approach excludes other factors (biological, psychological, religious, economical, political) that are all aspects of one's cultural experience. When race and ethnicity are overemphasized in conversations about healthcare disparities, the results can be polarizing because nursing remains a White, female-dominated profession. Also, emphasis on racial difference over other equally important differences sets up an "us versus them" dynamic between nurses that may lead to some minority nurses' disengagement from these initiatives. In addition, no one is immune to prejudice. Minorities are just as likely to have room for improvement in cultural competency.

Taking it all in

You can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion.

To avoid stereotyping, keep in mind that individuals within a particular group can vary in many respects. For example, among older adults, certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Many believe that all older people resist the use of modern technology; however, many people who are elderly enjoy using smartphones, tablets, electronic readers, and other devices. These intracultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. See Performing a cultural assessment for an example using the Giger and Davidhizar Transcultural Assessment Model.

In the United States, the healthcare system is a cultural entity with its own norms and values. Yet nurses may overlook a facility's institutional culture when they consider the impact culture has on patients' healthcare access and outcomes. Both organizational and hospital unit culture play a role in determining the quality of care a patient receives. When you can determine what interpersonal or institutional barriers exist within a particular institution, clinic, or community setting, you're better able to assist your patients in overcoming them to achieve better healthcare outcomes.

Goals and Considerations of cultural competency

How do you know whether you're providing culturally competent care? Some believe that they've reached the goal of cultural competency as they gain new knowledge or skills, or have encounters with culturally diverse groups. But while providers may meet goals, there is always room for improvement. Helpful questions and considerations when determining cultural competency include:

* What does being culturally competent mean to me and the patients I serve?

* Which cultural competency model and/or assessment tool is most useful to me, given my patient population?

* As I gain cultural knowledge and skills, how can I use that knowledge to improve my patients' healthcare outcomes and assist in reducing healthcare disparities for underserved populations?

* Did the patient demonstrate an understanding of what I was trying to convey or teach?

* What can I do to improve the quality of care I deliver to members of this group?

Title: Confident Voices: The Nurses' Guide to Improving Communication & Creating Positive Workplaces

Author: Beth Boynton, RN MS

Amazon Review:

“Confident Voices is a "must read" for every nurse who has had conversations with peers, supervisors, physicians and health care providers that have ended badly or wanted a different outcome. Confident Voices is designed to negotiate health care in the 21st Century and for communicating in a way that leaves everyone feeling included and honored in the process of day-to-day discussions in getting the job done. Beth Boynton's book provides the nurse with conversation tools to navigate difficult situations and provides support and feedback to reframe the situation so all involved win. I appreciate all the work Beth Boynton did in writing this book and the necessity of clear, concise communications in this difficult period we are all facing in the health care today.”

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Have you read Confident Voices? What did you think of it? Has it helped you communicate at work?

Are you a nurse who uses an iPhone? The iPhone is especially useful for nurses who are mobile, as this tool can help you stay in touch with medical teams and patients’ needs. Additionally, many new apps have been developed for the iPhone that fit a nurse’s lifestyle and professional requirements. Why carry 15 tools around with you when one will do the work for them all? Many of the iPhone apps listed below are not open source or free. And, many require wireless networks to operate. But, when you consider the cost of the tools you might need to simulate these apps, the app may be worth the investment.

The apps below are linked either to download sites or reviews with a link to the download site. They are listed in alphabetical order, a methodology that shows we don’t favor one app over another.

1. A.D.A.M. Symptom Navigator: If patients are using this app, maybe you should, too – easily find out what to do about any symptoms. Learn self care, when to go to the doctor, and when it is an emergency.
2. Bishop’s Score Calc: This obstetric calculator is used to calculate Bishop’s Score, a score used to assess probability of impending delivery as well as expected success rate if labor is induced. Expectant parents may also find this of use in aiding their obstetrician in determining whether induction of labor is reasonable.
3. Bio Dictionary: Bio Dictionary covers most of general biological terms. Two methods are offered for searching, and terms and their explanations are audible!
4. Cockcroft: Calculate the estimated clearance of creatinine (eCcr) with the creatinine serum rate (in mg/dL or in micromol/L). Weight can be either in kilogram or in pounds.
5. Epocrates Rx: One of the few free iPhone apps, Epocrates Rx includes a drug guide, formulary information and drug interaction checker. This product also includes continual free updates and medical news. Plus, this app resides on your device so you can look for information without wireless connections.
6. Eponyms for the iPhone: Downloadable through the iTunes store and courtesy of Pascal Pfiffner, this app brings the beautiful eponym database from Andrew J. Yee to your iPhone or iPod touch.
7. Glucose Charter: Glucose-Charter is a blood glucose, insulin and medication recording app for any iPhone. Patients can self-monitor, nurses can use it to check patients.
8. iAnesthesia: Case Logs: iAnesthesia: Case Logs allows all anesthesia providers to easily create, manage and backup case logs quickly in the operating room, leaving you with more free time when not at work.
9. iChart: Keep track of patients through this personal medical assistant. It stores everything from patient data to charts and lists of medications in a streamlined, organized fashion.
10. In Case of Emergency (ICE): You may not always practice in a hospital setting. If not, this app can provide you with all the information you need to contact emergency services in your location.
11. iRx: iRx is a pharmaceutical reference tool to get FDA information on specific drugs. This application is currently in beta status, but is fully functional.
12. Lab Tests: This laboratory test database is broken up into categories including, Blood Bank, Clinical Chemistry, Coagulation, Hematology, Serology, Immunology, Tumor Markers, Urinalysis and Therapeutic Drugs. Reference ranges and notes on the clinical significance of the test are given when indicated.
13. Medical Reference: Why memorize medical terminology when you can look it up on your iPhone?
14. Mediquations: Mediquations for the iPhone and iPod Touch brings over 201 common medical calculations and scoring tools to your fingertips with the simplicity and elegance you expect out of an iPhone application.
15. MIM Radiology: The MIM iPhone Application provides multi-planar reconstruction of data sets from modalities including CT, PET, MRI and SPECT, as well as multi-modality image fusion.
16. Mosby’s iTerms Flash Cards for Medical Terminology: Mosby’s iTerms Flash Cards for Medical Terminology, the premier study guide for mastering the prefixes, suffixes, combining forms, and abbreviations used to build medical terms, is now available for the iPhone and iPod touch.
17. NCLEX-RN Medications: Nursing students can cram for their NCLEX exam with this app that will help you study medications and conditions.
18. Netter’s Anatomy Flash Cards: Using outstanding anatomical illustrations from Netter’s hugely popular Atlas of Human Anatomy (4th Edition), Netter’s Anatomy Flash Cards allows you to carry the bestselling reference for human anatomy on your iPhone or iPod touch.
19. Netter’s Musculoskeletal Flash Cards: Master the musculoskeletal anatomy and pathology you need to know with 210 flash cards.
20. Netter’s Neuroscience Flash Cards: Enhance your understanding of key neuroscience concepts with Netter’s Neuroscience Flash Cards for iPhone and iPod touch.
21. Nursing Central: Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes premier disease, drug and test information by and for nurses.
22. Pocket First Aid Guide: Do you panic when caring for several people at once? Get a grip with this iPhone app. This is a first-aid guide for your iPhone that will help you treat anything from beestings to burns to eye injuries while you are within range of the Internet.
23. ReachMD: The ReachMD CME iPhone application is an easy-to-use and fully accredited Continuing Medical Education tool that gives healthcare practitioners a convenient way to earn free CME credits through their iPhone or iTouch.
24. ScribbleDoc: If you can’t read the good doctor’s writing, perhaps this app can help. Use your iPhone to scan the problem and ScribbleDoc should convert the image to text.
25. Skyscape Medical Resources: Available from the iTunes Apps Store, this app offers Outlines in Clinical Medicine, Archimedes – Medical Calculator, RxDrugs: Drug Dosing Tool and MedAlert for free with their download.

Thought you'd be interested to know The Institute for Diversity in Health Management is launching a new program designed to develop a pipeline of current mid-level health care managers for senior executive roles. This program will accelerate the preparation of minority leaders to represent the growing diversity of the U.S. patient population.

The course will feature nationally prominent CEOs and other senior health care leaders whose first-hand insights and leading roles in advancing American health care provide a model for future leaders.

Join us on Wednesday and Thursday, April 25 and 26 for a two-day seminar with the health care leaders. The cost is $975, which includes breakfast and lunch both days. Among other things you will learn: 

• The challenge of diversity for health care leaders
• How to define, develop and evaluate the role of the CEO
• How to formulate your personal CEO career strategy
• To "Run Toward the Roar" – how great CEOs identify and transform risk into opportunity
• How to manage the CEO relationship network

REGISTER TODAY

Program Cost: $975

When: Wednesday & Thursday, April 25 & 26, 2012 from 8 am - 4:30 pm Central Time

Where: 155 North Wacker Drive, Chicago, IL 60606

Contact: Craig Blassingame, (312) 422-2693, cblassingame@aha.org

 

1. Communication Skills

Solid communication skills are a basic foundation for any career. But for nurses, it’s one of the most important aspects of the job. A great nurse has excellent communication skills, especially when it comes to speaking and listening. Based on team and patient feedback, they are able to problem-solve and effectively  communicate with patients and families.

Nurses always need to be on top of their game and make sure that their patients are clearly understood by everyone else. A truly stellar nurse is able to advocate for her patients and anticipate their needs.

 

2. Emotional Stability

Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial. Some days can seem like non-stop gloom and doom.

That’s not to say that there aren’t heartwarming moments in nursing. Helping a patient recover, reuniting families, or bonding with fellow nurses are special benefits of the job. A great nurse is able to manage the stress of sad situations, but also draws strength from the wonderful outcomes that can and do happen.

3. Empathy

Great nurses have empathy for the pain and suffering of patients. They are able to feel compassion and provide comfort. But be prepared for the occasional bout of compassion fatigue; it happens to the greatest of nurses. Learn how to recognize the symptoms and deal with it efficiently.

Patients look to nurses as their advocates — the softer side of hospital bureaucracy. Being sympathetic to the patient’s hospital experience can go a long way in terms of improving patient care. Sometimes, an empathetic nurse is all patients have to look forward to.

4. Flexibility

Being flexible and rolling with the punches is a staple of any career, but it’s especially important for nurses. A great nurse is flexible with regards to working hours and responsibilities. Nurses, like doctors, are often required to work long periods of overtime, late or overnight shifts, and weekends.

Know that it comes with the territory. The upside is that a fluctuating schedule often means you’re skipping the 9 to 5, cubicle treadmill. Sounds perfect, right? Run errands, go to the movies, or spend time with the family — all while the sun still shines!

5. Attention to Detail

Every step in the medical field is one that can have far-reaching consequences. A great nurse pays excellent attention to detail and is careful not to skip steps or make errors.

From reading a patient’s chart correctly to remembering the nuances of a delicate case, there’ s nothing that should be left to chance in nursing. When a simple mistake can spell tragedy for another’s life, attention to detail can literally be the difference between life and death.

6. Interpersonal Skills

Nurses are the link between doctors and patients. A great nurse has excellent interpersonal skills and works well in a variety of situations with different people. They work well with other nurses, doctors, and other members of the staff.

Nurses are the glue that holds the hospital together. Patients see nurses as a friendly face and doctors depend on nurses to keep them on their toes. A great nurse balances the needs of patient and doctor as seamlessly as possible.

7. Physical Endurance

Frequent physical tasks, standing for long periods of time, lifting heavy objects (or people), and performing a number of taxing maneuvers on a daily basis are staples of nursing life. It’s definitely not a desk job.

Always on the go, a great nurse maintains her energy throughout her shift, whether she’s in a surgery or checking in on a patient. Staying strong, eating right, and having a healthy lifestyle outside of nursing is important too!

8. Problem Solving Skills

A great nurse can think quickly and address problems as — or before — they arise.

With sick patients, trauma cases, and emergencies, nurses always need to be on hand to solve a tricky situation. Whether it’s handling the family, soothing a patient, dealing with a doctor, or managing the staff, having good problem solving skills is a top quality of a great nurse.

9. Quick Response

Nurses need to be ready to respond quickly to emergencies and other situations that arise. Quite often, health care work is simply the response to sudden incidences, and nurses must always be prepared for the unexpected.

Staying on their feet, keeping their head cool in a crisis, and a calm attitude are great qualities in a nurse.

10. Respect

Respect goes a long way. Great nurses respect people and rules. They remain impartial at all times and are mindful of confidentiality requirements and different cultures and traditions. Above all, they respect the wishes of the patient him- or herself.

Great nurses respect the hospital staff and each other, understanding that the patient comes first. And nurses who respect others are highly respected in return.

Time spent and social sites visited outpace other US internet user groups

US Hispanics are more active on social media than the average US internet user, and are logging in more frequently to a wider variety of social sites.

The February 2012 “American Pulse Survey” from BIGinsight of US adult internet usage found that, while greater percentages of black internet users spent larger blocks of time online than the other groups studied, Hispanic internet users spent more of their online time on social media sites.

On an average day, 26.8% of Hispanic internet users spent six hours or more on social media sites, while 20.4% of black internet users and only 8.5% of total internet users spent that much time on social sites.

Looking specifically at which sites social-savvy Hispanics were using, the survey found US Hispanics were willing to participate in some newer and smaller social sites, logging in more often to networks like Pinterest, foursquare and LinkedIn, for example, than the average US internet user.

In the case of LinkedIn, 15.5% of US Hispanic internet users logged in to that site at least once a day, compared to 10.9% of black internet users and 4.9% of white ones. And, while 85% of white and 82.7% of black internet users reported not having an account on Pinterest, that number dropped to 71.5% among Hispanic internet users.

As marketers work to reach these active Hispanic internet users, data about which social sites Hispanics prefer and their frequency of use can be key to understanding where and when to connect with these consumers.

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